Basic Information
Provider Information
NPI: 1376526475
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CRAFT
FirstName: DAVID
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 833 CHESTNUT ST STE 520
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191074430
CountryCode: US
TelephoneNumber: 6723393558
FaxNumber: 6724671321
Practice Location
Address1: 1200 MANOR DR
Address2:  
City: CHALFONT
State: PA
PostalCode: 189142282
CountryCode: US
TelephoneNumber: 8003219999
FaxNumber: 2674791321
Other Information
ProviderEnumerationDate: 11/22/2005
LastUpdateDate: 02/15/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/15/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207XX0005X302845NYN Allopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
207XX0005X25MA10628400NJN Allopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
207XX0005XMD042305LPAY Allopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine

No ID Information.


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